Childhood Stroke
/
Childhood Stroke
‹ Return to Disorder Directory

Childhood Stroke header image.

Author: Adam Kirton, MD, University of Calgary/Alberta Children’s Hospital
Reviewed: April 2021 

SUMMARY

A stroke happens when blood vessels in the brain get blocked or brokenThe result of a stroke is damage to the brain. Childhood stroke has several known causes. However, many causes are not well understood. A careful clinical examination and brain imaging can help diagnose strokeEarly treatment for stroke focuses on two things. The first is protecting the brain. The second is keeping its blood vessels open. 

Most children with stroke will experience long-term neurological problems. They will likely require years of treatment. These treatments can address physical, developmental, and psychosocial complications from stroke.  

JUMP TO

Disorder Overview

DESCRIPTION AND DEFINITIONS 

Children can experience three types of stroke. 

Arterial Ischemic Stroke (AIS)

Arterial ischemic stroke is the most common type of childhood stroke. AIS occurs when an artery is blocked by a blood clot.  

Arteries are the blood vessels that carry blood to the brain. Two pairs of arteries carry blood in the neck. The first pair are located at the front of the neckThey are called the carotid arteriesThe second pair are located at the back of the neck. They are called the vertebral arteries. 

After reaching the brain, these arteries connect in a circle. This circle is called the Circle of Willis. From there, the arteries spread out like tree branches. The largest branch is the middle cerebral artery. A lack of blood flow in these branches can lead to brain damage within minutes. This lack of blood flow is known as ischemia. The damage that results is a stroke. 

Cerebral Sinovenous Thrombosis (CSVT)

In cerebral sinovenous thrombosis, blood clots occur in veins in the brain. The largest veins are called sinuses. Like all veins, sinuses carry blood back to the heart. Sometimes a blood clot occurs in the veins or sinuses. A clot can block the drainage of blood from the brainClots related to CSVT may lead to brain damage when they prevent blood flow.    

Hemorrhagic Stroke (HS)

When a blood vessel breaks, or “hemorrhages,” in the brain, it causes a hemorrhagic strokeDuring a hemorrhagic stroke, blood spills directly into brain tissue or spaces beside the brain. This can cause damage to the brain.  

SYMPTOMS AND PHYSICAL SIGNS 

Most strokes in children present with the SUDDEN ONSET of symptomsThese symptoms are neurological in nature. 

Common examples include: 

  • Weakness of one side of the bodyWeakness on one side of the body is called hemiparesis. Hemiparesis usually occurs in the face, arm, or leg. 
  • Difficulty speaking. A child may have difficulty making or understanding speech. 
  • Vision abnormalities. Vision loss occurs in one part of the visual world (e.g. they cannot see one half of the world regardless of which eye they use) or double vision. 
  • Dizziness or imbalance. A child may experience poor walking or coordination. 
  • Numbness of one side of the body.  A feeling of decreased sensation or tingling.

These signs and symptoms may occur only brieflyWhen these symptoms resolve quickly, it is called a transient ischemic attack (TIA). TIA symptoms may be a warning sign for stroke. 

Other symptoms may happen. 

However, these conditions are usually due to something other than stroke: 

  • headache 
  • seizures 
  • drowsiness 
  • confusion 

RISK FACTORS AND CAUSATION 

 The causes of stroke in children are not well understood. There is usually nothing a child, parent, or anyone else could have done to prevent a stroke. First strokes in children are nearly impossible to prevent.  

Some children have multiple risk factors that combine to result in stroke. Others have no risk factors, but still experience strokeSometimes medical professionals can find no risk factors in spite of extensive investigation. In these cases, they use the term idiopathic stroke.   

Possible Causes of Arterial Ischemic Stroke (AIS) in Children

Arteriopathy 

Arteriopathy means “sick artery. There are various arteriopathies that can lead to childhood AISArteriopathy can be related to: 

  • Focal cerebral arteriopathy (FCA). FCA generally occurs in healthy children. It affects the arteries on one side of the brainIprogresses over days or weeks. The exact cause of FCA is unknown. However, it may relate to recent infection.  
  • Vasculitis. An inflammation of the blood vessels is called vasculitis. Focal cerebral arteriopathy (FCA) may be a form of vasculitis. 
  • Infection. Certain infections can directly cause artery problems. Bacterial meningitis is an example. 
  • Dissection. A tear in the wall of an artery is called dissection. Some dissections are associated with physical trauma. 
  • MoyamoyaMoyamoya is progressive narrowing of the carotid arteries on both sides of the brainIt can cause compromised blood flow, clot formation, or bleeding. Moyamoya is usually related to a genetic condition. 
  • Genetics. Several other rare genetic conditions may lead to arteriopathy. 

 Heart Conditions 

Heart conditions are a major risk factor for childhood AISComplex congenital heart disease can include malformations in heart development. These can increase the risk of stroke. So can the surgical procedures used to treat them. 

 Other cardiac risks for AIS include: 

  • low heart function 
  • abnormal rhythm 
  • valve disease 
  • heart infection (endocarditis) 
  • treatments for severe heart failure 

 Blood Conditions 

 Blood conditions may contribute to AIS in children.  

  • Blood clotting disordersThese are also called thrombophilias or prothrombotic disorders. 
  • Sickle-cell disease. Sickle-cell is a genetic blood condition that carries a very high risk of stroke.  
  • Iron deficiency anemia. Anemia is a common condition in young children. In rare instances, it is associated with stroke. 

Possible Causes of Cerebral Sinovenous Thrombosis (CSVT) in Children

  • InfectionsBacterial meningitis and serious middle ear infections can cause CSVT 
  • DehydrationIncreases the risk of abnormal blood clotting 
  • Blood clotting disorders.  These are also called thrombophilias or prothrombotic disorders. 
  • Systemic diseasesSome medical conditions can increase the risk of CSVT. Examples include inflammatory bowel disease, nephrotic syndrome, and many cancers. Their treatments can also increase the risk of CSVT. 
  • TraumaPhysical injury to the sinuses can lead to CSVT. 

Possible Causes of Hemorrhagic Stroke (HS) in Children

Hemorrhagic stroke often involves the rupture of an abnormal blood vessel in the brain. Blood disorders or other conditions may also be responsible. Possible causes of HS include: 

  • Arteriovenous malformations. These are abnormal tangles of arteries and veins. They are the leading cause of hemorrhagic stroke in children.  
  • Cavernous malformations. These are another type of vascular malformationThey involve smaller blood vessels in the brain 
  • AneurysmsAneurysms are outpouchings of cerebral arteries. They are uncommon in children. However, they may be involved in the genetic, infectious, and traumatic causes of HS 
  • Arteriopathies. Some arteriopathies can also predispose a child to hemorrhagic stroke. 
  • Blood disordersSome disorders impair the blood’s ability to clot. These can increase the risk of hemorrhagic stroke. Examples include:  
    • genetic conditions (such as hemophilia)
    • disorders of the coagulation system (such as liver failure) low blood platelets
    • the use of some medications 
  • Brain tumors and physical trauma. Both tumors and trauma can lead to hemorrhagic stroke.

DIAGNOSIS: NEUROIMAGING 

A neurologist requires brain imaging to diagnosstroke in children. This brain imaging can be used to assess the brain and its blood vesselsThere are two types of brain imaging techniques. The first is called a CT scan, and the second is called an MRI.

Computer Assisted Tomography (CT or CAT) Scan

Computer assisted tomography scans are quick and widely available. CT scans do not require sedation or anesthesia because they can be done in minutes. They are good at detecting strokes. CT scans can produce images of the brain’s arteries and veins. CT angiography (CTAcan produce images of arteries. Meanwhile, CT venography (CTV) can produce images of veins. 

Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging is the most sensitive test available for diagnosing a stroke in children. However, its longer scan times may require sedation for younger children. Like CT scans, MRIs can produce images of the brain’s arteries and veins. MR angiography (MRA) can produce images of arteries. MR venography (MRV) can produce images of veins.  

Figure. Neuroimaging studies in pediatric stroke.
(A) A CT scan shows an arterial stroke as a dark area. (B) An MRI shows an arterial stroke very clearly. (C) An MRA shows an occluded arterial branch. (D) A CTV shows problems in the venous sinuses. This allows for a CSVT diagnosis. (E) A CT scan is good at demonstrating hemorrhagic stroke.

LABORATORY TESTS 

Neuroimaging  (CT scans and MRIs) can confirm diagnosis of stroke in children. They can often identify a stroke’s primary cause. However, many children require further laboratory tests in order to uncover possible risk factors. 

Doctors may order the following laboratory tests: 

  • Echocardiograms (ECHO). ECHOs create an ultrasound picture of the heart. 
  • Electrocardiograms (ECG). ECGs trace the heart’s rhythm. 
  • Electroencephalograms (EEG). EEGs test brain activity. They may be useful in evaluating seizure-related complications of stroke. 
  • Blood clotting tests. These tests can exclude bleeding or clotting disorders 
  • Other blood tests. Other blood tests include cell counts, kidney and liver tests, and inflammation marker tests. 
  • Lumbar punctures. Lumbar punctures test for infection or inflammation. They are also called “spinal taps.” 

THERAPEUTIC INTERVENTIONS 

The early treatment of childhood stroke focuses on protecting the freshly injured brain. Early treatmentfor stroke include: 

Neuroprotection

 Neuroprotection means using supportive measures to minimize brain injuryFor instance: 

  • correcting dehydration  
  • maintaining normal blood sugars
  • avoiding increased body temperatures  
  • treating infections 
  • recognizing and treating seizures  
  • maintaining good blood pressure (this optimizes blood flow to the brain) 

Additional Early Management Methods

Other early management methods vary based on the type and cause of stroke. 

  • Antibiotics. Strokes related to infection usually require antibiotics. 
  • Corticosteroids. Strokes related to inflammation may be treated with steroids. 
  • Blood transfusions. Strokes related to sickle cell disease may require blood transfusions. 

Opening Blocked Vessels

Opening blocked vessels is known as recanalization. Opening blocked vessels is sometimes used to treat childhood stroke. However, evidence of its safety and effectiveness in children is limited. Methods include: 

  • thrombolytic, or “clot busting,” drugs
  • special procedures to manually remove blood clots 

Blood Thinners

Bloodthinning medicines are safe for use in children with stroke.  

Blood thinners help prevent the growth or development of new blood clots. The type and duration of a blood thinner can vary. The two primary blood thinner types prescribed after a childhood stroke are: 

  • those that affect the coagulation system (such as heparin) 
  • those that affect the platelets (such as aspirin) 

Preventing Increased Intracranial Pressure

High pressure in the head is immediately life threatening. Increased pressure may occur immediately after a hemorrhagic stroke. It may also occur within days of any type of strokeSome individuals may require neurosurgery to alleviate this pressure. 

OUTCOMES AND CHRONIC MANAGEMENT 

Outcomes from childhood stroke vary. Many factors determine the outcomes of childhood stroke. However, only some of these factors are understood. Therefore, it is difficult to predict an outcome soon after a stroke. Virtually all children will improve with time.  

Childhood stroke may include long-term complications. However, there are established methods for managing these complications. 

  • HemiparesisWeakness on one side of the body is a common complication of childhood strokePediatric occupational therapists and physical therapists can help treat hemiparesis in children.  
  • EpilepsyChildhood stroke can lead to recurrent seizures. These seizures can often be managed with medication.  
  • Language disorders. Language disorders may include difficulty with speaking or with understanding language. Therapy from a speech-language pathologist can help. 
  • Movement disordersAbnormal movements of an arm or leg may sometimes be treated with therapy and medication. 
  • Cognition and learningChanges in cognition or learning ability may require examination by a neuropsychologistTalking to teachers and education experts can also help. 
  • Family mental healthStruggles with mental health can be common in family members after a childhood stroke. Screenings for depression, anxiety, and other mental health conditions are sometimes required. Family-centered care models and peer-support groups can be beneficial 

STROKE PREVENTION 

Depending on its cause, a childhood stroke may carry risk of recurrenceHowever, some established strategies can help prevent recurrence. These include:  

  • regular follow-ups and repeated imaging (for high-risk conditions) 
  • antithrombotic therapy, often with aspirin  
  • anticoagulation therapy, often with warfarin  
  • special surgeries (for conditions like moyamoya) 
  • special treatments, such as blood transfusions (for sickle cell disease) 
  • basic principles of good health, including an active lifestyle and balance diet 

Resources 

ORGANIZATIONS/GROUPS 

Little Stroke Warriors Australia (Facebook community group)
Little Stroke Warriors Australia is a group of families and survivors of paediatric stroke. It provides families and caregivers with a supportive community to help steer them through the journey of stroke recovery. Little Stroke Warriors also raises awareness of paediatric stroke throughout Australia, to make sure all paediatric stroke survivors get the treatment and care they need, and that their families are well supported.  

Little Stroke Warriors also hosts a private Facebook group that anyone worldwide can join: Little Stroke Warriors Support Group. 

Fight the Stroke Foundation (Based in Italy)
FightTheStroke exists to answer the need for knowledge and support for families impacted by the management of a young stroke survivor and with a disability of Cerebral Palsy; to educate to the awareness that children, even those not yet born, can be affected by stroke; to inspire the new generations and encourage research and adoption of innovative therapies. Although based in Italy, FightTheStroke actively collaborates internationally on scientific and social innovation.

International Alliance for Pediatric Stroke 
The International Alliance for Pediatric Stroke (IAPS) is dedicated to building awareness, expanding education, providing support, and advancing research on behalf of children and their families, leading to a timely diagnosis, treatment, and prevention of pediatric stroke. The website contains vetted, useful information, the IAPS Support Network, resources, stories, and much more.

Pediatric Stroke Parent Support Group (Aurora, Colorado) 
The Pediatric Stroke Parent Support Group is a monthly meeting for families of stroke survivors. This community provides support, education, and advocacy for families impacted by the range of outcomes of all types of pediatric strokes. Normally the group meets in person on the second Tuesday of the month. However, due to COVID-19, the group has been meeting online via Zoom. Anyone is welcome to join the online meetings. Please check the website for up-to-date meeting information. Connect via Facebook or email: strokesupport@ucdenver.edu 

International Pediatric Stroke Organization  
The mission of the International Pediatric Stroke Organization (IPSO) is to improve the lives of children with cerebrovascular disease worldwide through research, education, clinical care and advocacy. IPSO’s vision is a world in which international, multidisciplinary collaborations advance the understanding, care, and outcomes of childhood cerebrovascular disease. 

KISS Pediatric Stroke Support Group (Facebook private group)
KISS Pediatric Stroke Support Group is a safe space offering not just support to the parents and caregivers navigating the often overwhelming journey of life after pediatric stroke, but it’s also a place to ensure that all stroke families are up to date on the most cutting-edge information pertaining to pediatric stroke: research, educational tools, and advocacy campaigns to support and rally for our children both in our local communities and worldwide. 

The Stroke Association (UK based)  
www.stroke.org.uk
 
The Stroke Association’s core purpose is to be the trusted voice of stroke survivors and their families, and to drive better outcomes in stroke prevention, treatment, and lifelong support for everyone affected by stroke. The Childhood Stroke section of the website https://www.stroke.org.uk/childhood-stroke includes information, publications and resources.

PUBLICATIONS 

Our Family’s Stroke Journey (2020)
Downloadable family guide from the Stroke Foundation in Australia which addresses: 
What is a stroke? How can stroke affect my child? What treatment and care will my child receive? What do I need to know about life after my child’s stroke? What help is available? 

Pediatric Stroke Family Tool Kit 
The International Alliance for Pediatric Stroke has published the Pediatric Stroke Family Tool Kit, a must-have guide for anyone who has a baby, child, or teen who has had a stroke. The Tool Kit is available online to download, flip through, and printed copies are also available at no cost.

Fact Sheet
Fact sheet created in partnership between International Alliance for Pediatric Stroke and the American Stroke Association. Appropriate for sharing in the community, on social media, schools, physicians’ offices. Printed copies are available through contacting IAPS at info@iapediatricstroke.org. 

Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF. 

Research 

ClincalTrials.gov for Pediatric Stroke are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently.  

ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.  

Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits. 

Family Stories 

Meet over 70 children and teens from all over the world who have been impacted by stroke and read Pediatric Stroke Stories from International Alliance for Pediatric Stroke. 

All four of these girls from Kansas City, MO suffered massive strokes during their high school careers. After long and hard recoveries, all four were able to graduate on time. 

This powerful video from the American Heart Association is a reminder that strokes can happen at ANY age. The full version of this video can be found here.   

The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only.  CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. 

References

Reviews and Guidelines:

Ferriero DM, Fullerton HJ, Bernard TJ, Billinghurst L, Daniels SR, Debaun MR, et al. Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. 2019;50(3). http://doi.org/10.1161/STR.0000000000000183 

Giglia TM, Massicotte MP, Tweddell JS, Barst RJ, Bauman M, Erickson CC, et al. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease. Circulation. 2013;128(24):2622–703. http://doi.org/10.1161/01.cir.0000436140.77832.7a 

Ichord R. Cerebral Sinovenous Thrombosis. Frontiers in Pediatrics. 2017;5. http://doi.org/10.3389/fped.2017.00163 

Kirton A, Deveber G. Paediatric stroke: pressing issues and promising directions. The Lancet Neurology. 2015;14(1):92–102. http://doi.org/10.1016/S1474-4422(14)70227-3 

Lo WD. Childhood Hemorrhagic Stroke. Journal of Child Neurology. 2011;26(9):1174–85. http://doi.org/10.1177/0883073811408424 

Medley TL, Miteff C, Andrews I, Ware T, Cheung M, Monagle P, et al. Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke. International Journal of Stroke. 2018;14(1):94–106. http://doi.org/10.1177/1747493018799958 

Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U, et al. Antithrombotic Therapy in Neonates and Children. Chest. 2012;141(2). http://doi.org/10.1378/chest.11-2308 

Sinclair AJ, Fox CK, Ichord RN, Almond CS, Bernard TJ, Beslow LA, et al. Stroke in Children With Cardiac Disease: Report From the International Pediatric Stroke Study Group Symposium. Pediatric Neurology. 2015;52(1):5–15. http://doi.org/10.1016/j.pediatrneurol.2014.09.016 

Thank you to our 2021 partners Acadia, bluebird bio, Greenwich Biosciences, Liva Nova, Origin, PTC Therapeutics and UCB for their support of the Disorder Directory.

Start typing and press Enter to search

Shopping Cart
Skip to content